Radiotherapy doses at special reference points correlate with the outcome of cervical cancer therapy

The authors analyzed the correlation between radiotherapy doses at reference points on the uterine edge and the rectal wall and both pelvic control and late rectal complications of cervical cancer therapy.

Between 1997 and 2005, 57 patients with Stages IB-IVA cancer of uterine cervix were treated with a combination of external beam radiotherapy and high-dose-rate intracavitary brachytherapy. Their high-dose-rate intracavitary brachytherapy was planned by dose-point optimization at six dose points located on the edge of uterus by computed tomography. A rectal reference point located on the anterior wall of the rectum by computed tomography was also used. The pelvic control rate and the rate of late rectal complications were calculated according to the biologically effective dose (BED) at each point and several clinical parameters.

The overall 3-year pelvic control rate was 69.4%. The patients with a BED >80 Gy10 at the point on the edge of the uterine cervix had better pelvic control (78.4% at 3 years) than the patients with a BED < or =80 Gy10 (54.4% at 3 years), and the difference was significant. The difference in the BED (Gy3) at the rectal reference point between the patients with Grade 0-1 late rectal complications (median, 114 Gy) and the patients who developed Grade > or =2 late rectal complications (median, 178 Gy) was significant. Chemotherapy was a borderline significant parameter in regard to correlation with pelvic control and late rectal complications, but there were no correlations with other dosimetric or clinical parameters.

The radiotherapy dose at the reference point on the edge of the cervix affected pelvic control more than the clinical parameters, and the dose at the rectal reference point was more strongly correlated with the occurrence of late rectal complications.